Shhh... The Health Care Bill is Working (Just Don't Tell Anyone)

[Swede]

The fact that such a complex Federal program -- which had to create myriad rules and regulations and interface with 26 state governments -- could achieve this in a timely manner, without tales of massive waste, fraud, abuse or scandals of any kind is a tribute to Katherine Kathleen Sebelius, Secretary of Health and Human Services, and the team she chose to implement the plan.

Not that you'd know it if you weren't paying very careful attention. Despite the fact that these pools are now providing tens of thousands of people with insurance coverage and medical treatment if they need it -- people who couldn't obtain it before at any price -- you'd barely know from the press coverage or from the administration that the program was operational and helping people.

Here's some clippings from the few stories out there about how the pool is helping.

http://www.dailykos.com/storyonly/2010/9/12/901072/-Shhh...-The-Health-Care-Bill-is-Working-(Just-Dont-Tell-Anyone)

[Recursion]

1. Uh oh

:hide:

We can't have any talk of HCR not being a total failure here...

[Skittles]

3. it's not that it didn't help at all

it's just that it could have, and SHOULD have, been so much better

[Recursion]

13. I have no problem with that sentiment

I do have a problem with a large portion of DU saying it's a step in the wrong direction, rather than an insufficient step in the right direction.

[notadmblnd]

15. Could you point out an instance when someone from DU said it was a step in the wrong direction?

I haven't seen it.

[Recursion]

17. You're joking, right?

Are you seriously asking that?

[Skittles]

22. being forced to buy from the same insurance companies causing the problem

is a HUGE misstep

[Recursion]

24. I don't know that it's established that the insurance companies are "causing the problem"

They're contributing, certainly, but so is every other part of the health care system, including us patients.

[Skittles]

27. do not say US patients

I'm in perfect health and take no prescriptions yet I have to pay out the ass for crap "insurance"

[Recursion]

29. I have it for the "hit by a bus" scenario

What will you do if, God forbid, you're hit by a bus?

[Skittles]

35. again, PAY OUT THE ASS

[Recursion]

37. But then the rest of us pay in that case too

Since the ER would probably not be able to recoup the entire cost from you. So, we will pay more. This is the point of the mandate, to make sure everyone who gets a benefit from the health system pays into the system.

[Skittles]

62. PAY OUT THE ASS WITH DEDUCTIBLES AND CO-PAYS ETC

healthcare "REFORM"? Please. :rofl:

[Recursion]

64. Wait. You said you don't have insurance

So how do you have deductibles and copays?

[Skittles]

68. ???

when did I say I don't have insurance?

[Recursion]

69. Sorry! I misread #27

I thought you said "I have yet to pay for crappy insurance" instead of "yet I have to pay for crappy insurance".

[Hello_Kitty]

93. Um, if you get hit by a bus the bus company probably has insurance for that.

You should pick another example.

[notadmblnd]

92. No, I wasn't joking

I understand that people are not happy with the insurance "reform" that was passed (me being one of them), but that does not mean that I am against reform.

I see that you edited out your statement bashing DU'ers, and that is why I asked you to point out those posts.

I for one am tired of people coming here and painting us with a broad brush without posting specific examples. So I get flamed for my statement instead of you, but that's ok, I'm a big girl, I can take it.

on edit: I'm sorry, you did not remove that statement, it was in another post #27 to be specific. That is the statement I was responding to. I apologize for the misunderstanding. But I still feel that broad brush painting of DU is wrong and would like specific examples of people saying it is a step in the wrong direction.

[Safetykitten]

55. Here I am! It sucks. It sucks completely. A nightmare that will be with us for years, and

these little vignettes of happiness, trotted out to do the "see? look it works!" do not change anything. Of course it will help some. A very few some. Is that the level of sucess now? The fact that millions STILL can't get healthcare, so lets just focus on the happy stories that allegedly show progress.

Or is it the paradox of not being able to afford ANYTHING and still not be able to get healthcare? Why are people who need help even charged for it when they are poor?

No, just no, this clusterfuck will be pastime of politicians in the years before "full implementation" to scamper away as fast as they can from any responsibility for putting it into place.

Evil, cynical, wrong, and lastly the biggest laff-riot of more civilized societies on the planet, this thing is not anything to be proud of.

[bvar22]

99. I say that, and stand by it.

The foundation of this bill, Mandatory Purchase of Insurance from a For Profit Vendor IS a "step in the WRONG direction."
This will postpone REAL reform for a generation.

The handful of good regulations in this bill could have ALL been achieved with single, clean bills imposing regulation on the Health Insurance Industry, brought to the floor for Up or Down votes.

We did NOT have to eat the whole Shit Sandwich to get these few regulations.

To appreciate how BAD this bill is, simply compare it to what is taken for granted in every single civilized country in the WORLD.

[Vincevega]

41. step in the wrong direction?

I have been reading a lot of HCR journals and am yet to see anyone says it a step in the wrong direction. It could have been much better but as they say "we got what we could" and "it will be fixed". Lets just hope the dems get a bigger majority for the votes needed to enact the changes.

[Recursion]

43. Read almost any HCR thread

I've seen it a lot. "It's just a giveaway to the insurance industry". "It's making things worse". etc.

[Vincevega]

50. I agree

its a give away to the insurance companies but at the same time is an improvement on the current system. Its political horse trading, the insurance companies get something for agreeing to the new regulations and reforms

[jgraz]

81. In fairness, it's both

There are many steps in the wrong direction (drug patents,mandated private insurance) and a few insufficient steps in the right direction (pre-existing conditions, wider coverage).

[aquart]

2. Not a comfort to those with 35% increases however.

[pnwmom]

6. Their increases would have been much higher over the next several years,

according to the non-partisan Congressional Budget Office.

Thanks to the measures put into place, the trend has already significantly lowered the upward curve.

[Vincevega]

45. again thats no comfort

to the people FORCED through the mandates to purchase policies from the insurance companies. At least before u can opt out if the bill became to expensive. The mandates and the lack of price control are my biggest problem with the bill.

Edit: and lack of drug importation

[pnwmom]

52. And if you opted out and ended up getting care through

the emergency room? Then we all pay more so that you could opt out.

[Missy Vixen]

80. What's the difference between unaffordable and unaffordable?

I wrote an entire thread about this a few weeks ago after looking up what the premiums would be for Mr. Missy Vixen and I under "health care reform". We are both over 40, non-smokers, with pre-existing conditions.

Our premiums are $878 per month with a $2500 deductible. My husband's medications are $500 per month. He must take them to stay alive. The $878 per month is the amount of a second primary mortgage for us.

Here's the thread if you don't believe me, and somehow, I'm sure there will be several here that won't...

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=8970406

[Recursion]

82. That's pretty much exactly the unsubsidized Medicare premium

Though the deductible in that case is only $1000. Insuring people who are likely to need treatment is expensive. It sucks that the subsidies don't kick in until 2014; I wish that part started sooner.

[bighart]

97. Can you give evidence to prove your claim or is that just speculation?

[dkf]

4. Beats me why we had to pass the other stuff to get these pools.

The mandate will always bother me. Freedom indeed.

[Recursion]

8. The mandate is so people won't wait until they get sick to get insurance

Like Krugman says, all the parts are mutually dependent; they don't work without each other.

[dkf]

14. Then it should have been a no profit public option and we call it a tax.

Otherwise it's forced profits to health insurance companies. Disgusting.

[Recursion]

18. There's required to be a non-profit provider in the exchange

And as a practical matter there are already non-profits available to almost everybody; my insurance is through a non-profit HMO, for instance.

And the penalty for not getting insurance is, in fact, a "tax". That's why the IRS collects it.

[dkf]

23. Not everyone is eligible for the exchange. Yet another problem.

And a lot of people will decide not to take insurance and will land up at the same ER room they land up at now.

[Recursion]

26. It remains to be seen how many people will pay the tax rather than buy insurance

The exchanges will be open to anyone who:

1. Is not offered insurance through their employer, or
2. Cannot find a plan that costs less than 9.5% of their income

Employers will pay a tax penalty for every employee who has to participate in an exchange.

If the 20 million or so legally-employed Americans who do not have insurance do not participate when the exchanges open, then yes, this will have been a colossal waste of time.

This still leaves the problem of 23 million illegal immigrants who will not be able to participate in the exchanges.

[dkf]

34. So I don't have the option to buy into the exchange. Yet I had exactly ONE option this past year

And I'm avoiding using it because the usual and customary costs are tiny compared to the true cost resulting in big out of pocket costs. One person that used it landed up paying 80% of the bill because the payout was so minimal even though the plan is supposed to cover 80% with the patient paying 20%.

And last year my eye doc was covered under my medical plan while this year I had to get a separate vision plan and the doc landed up being covered only for surgical services. I specifically checked to make sure this doc was covered but when push came to shove nothing was covered by my vision plan, not my appointment, nor my lenses. Insurance is a joke.

[Recursion]

40. I've always received insurance through my job

So I've never really had options; I get the plan my HR department chooses. I don't really know what the individual insurance market looks like from the perspective of a consumer, though part of the point of HCR is essentially getting rid of that market.

[dkf]

46. I tell you what though...I trust a government option more than private insurance profit or non

I read the congressional testimony from one of the doctors who used to review claims. They will do what it takes to not pay out a claim. It kills me that we had an opportunity to create a system I could trust and these idiots decided not to take it.

And yes I know the exchange is still administered by the bad guys, but at least there is recourse and supervision.

This is the ONE service I would ask my Government for. I don't need handouts, nor tax cuts, etc. All I want are health options I can trust.

[Recursion]

47. Medicare denies a greater percentage of claims than any private insurance company

Medicare denies about 7% of claims; the average for private insurance (for-profit or not-for-profit) is about 4.5%.

Medicare can do this because doctors who take Medicare patients are pretty much stuck. If private companies deny too many claims doctors just stop taking their patients.

(Edit: Apparently that was a fluke of 2008; the 2009 numbers are 4% and 2%.)

[dkf]

58. What are they denied for? Fraud?

Ironically I did have an experience where a hospital told me they had to keep my uncle in the hospital and would not release him until he had 24 hour supervision. Then they found out Medicare wouldn't cover it and I had to pick him up that day.

But my point is that Medicare doesn't ask their doctors/approvers to make up excuses to not pay claims nor to kick people out of the system. And I dare say my uncles case was a denial by Medicare which didn't turn into a denial by the hospital because they just kicked him out.

[Recursion]

60. The same reason private insurance companies deny claims: money

But my point is that Medicare doesn't ask their doctors/approvers to make up excuses to not pay claims nor to kick people out of the system.

Just like private insurance companies, Medicare pays people to approve (that is to say, approve or deny) claims. Just like insurance companies, Medicare tries to provide care to its "customers" on a finite budget.

[dkf]

70. If this is the way it works I prefer the Medicare system.

http://webkit.dailykos.com/stories/2009/10/6/05110/6076.html

LordMike wrote:

  1.   If you have a claim denied over stuff that is not covered, you can not only appeal, but you can actually go to a judge!  You can't do that with private insurance.  Most appeals are successful.
 

 Denials to hospitals and healthcare providers may be higher, but the patient doesn't feel it.  Why?  If the hospital screws up billing, they have to eat the error entirely.  THE PATIENT PAYS **NOTHING** IF THE CLAIM IS DENIED and the patient was not told that the procedure is not covered.  The hospital/doctor has to eat the cost 100%
 

 As a result of this, hospitals are really good at making sure they bill things appropriately to get paid.  As a result, there are very few problems for medicare patients.

[Recursion]

76. Except the hospital doesn't eat the error entirely

They charge those of us who have private insurance more. The actual cost of the procedure doesn't disappear.

A lot of what we like about Medicare is only possible because the rest of us are paying so much through private insurance.

[bvar22]

100. We already HAD "non Profit Providers" BEFORE this bill.

We already had Community Health Centers before this bill too.

I love how the politicians take credit for things we already had while shoving Mandates with NO Public Option down our throats.

Think its bad now?
Wait until 2014 when the REAL bomb explodes.
30 Million Americans are going to be FORCED to BUY worthless Health Insurance they won't be able to afford to use.
BOOM!!!
Democrats unelectable for a generation.

[pnwmom]

10. Because the pool would never be affordable to the sick, or those

with preexisting conditions, if it didn't also include the young and healthy -- those who would likely not choose to join without a mandate. By spreading the costs around to everyone -- those who currently need treatment and those who will need it in the future -- costs are made manageable for everyone.

Is that really so hard to understand?

[dkf]

16. In a country that values freedom yes.

[pnwmom]

20. Then you don't believe in Social Security either, which is required.

Or k-12 education, which is also mandatory.

You sound more like a Teabagger than a Democrat.

[dkf]

28. I believe in taxing to provide public services. Not to pay juicy salaries to execs.

As to social security I'm still confused if it is a tax or not. If it is a tax I don't believe I should expect any benefit from it. If it isn't a tax then it isn't a tax.

[Recursion]

30. What we call levies has an interesting history

They are generally not called "taxes", so that raising them is not called a "tax increase".

[pnwmom]

51. The Social Security tax is a tax. What is confusing about that? n/t

[dkf]

71. If you believe that you shouldn't insist it is an eternal obligation.

You don't get bunk for taxes paid.

[doc03]

11. I have no problem with repealing the mandates, if they

don't want to buy insurance don't come to the taxpayer wanting health care. They are on their own.

[Recursion]

12. Except they aren't -- hospitals still have to treat them, on our dime

If you want to repeal the requirement that ERs treat all comers, that could "work", I suppose.

[dkf]

19. That is what Bernie Sanders free health clinics should address.

[Recursion]

21. Yup. The extra funding for FQHCs is a huge plus for this bill

And hopefully they will take some of the cost out of the insurance system.

[dkf]

25. I would have made this the backbone of service to the poor.

Forget having to deal with insurance companies and all these shenanigan prices.

[Recursion]

31. We may be heading that way

Sanders projected that by the end of the decade FQHCs will be doing most routine and preventive care (there's a complex cost-sharing rule that kicks in I think in 2015 that will start shifting Medicaid routine and preventive visits to them, in an attempt to save state Medicaid budgets). Sounds good to me.

[dkf]

38. Oh yeah. The best medical service is one that is competent and leaves no debt.

Sometimes it's the cost and the burden that kills you.

[Recursion]

5. I think people here may get scared off by the premiums

Even though as the article points out those are the same premiums paid by people without pre-existing conditions.

[HuckleB]

7. Yup, and yup.

[Recursion]

9. People like me with employer-based insurance are in the dark about how expensive it actually is

Though that's going to change starting with next year's W2.

[HuckleB]

32. I know how expensive it is, and I'm lucky enough to have employer coverage.

But you're right, a lot of people don't pay attention.

[Recursion]

33. I don't, because my employer doesn't have to tell me

I mean, practically I'm pretty sure that if I walked into HR and asked they would probably tell me, but they aren't required to now. Though starting in January they will be.

[HuckleB]

My employee has been telling me for years.

It has been a "look how much we ACTUALLY pay you" routine.

I have no complaints. My employer is awesome, but it's kind of funny.

[frazzled]

36. Yeah, but you'd get more scared by your first hospital bill

We just got the hospital bill in the mail today for a slightly less than 48-hour hospital stay mr. frazzled underwent a couple of weeks ago. A hematoma he'd gotten in an accident several months earlier suddenly got inflamed, and his doctors told him to get to the emergency room. It was a staph infection, and they admitted him to the hospital for tests and IV antibiotics. The bill? $9,300.

Divided over a 12-month period, that one infection would cost $775 a month. This doesn't include the costs for the rest of this bicycle accident: ambulance, emergency room, X-rays and CT scans, broken bones to be seen by orthopedic surgeon, punctured lung seen by thoracic surgeon, physical therapy, and, ultimately, same-day surgery in hospital later for the hematoma. You, too, could fly off your bicycle. Our insurance is (I think) covering all of it, or almost all (we'll see). Altogether, I'm guessing he racked up at least $20,000 in costs from one little accident.

When you think of it that way, $300-400 a month ($3600-4800 a year) for high-risk insurance doesn't sound so bad. You don't have to be sick to rack up big medical costs. You could get whacked playing touch football and end up in the poorhouse getting fixed.

[Recursion]

39. Exactly. Insurance is expensive because health care is expensive

If we could get health care costs down, keeping a private insurance system would be fine.

If we can't get health care costs down, any system (including single payer) will be very expensive.

[Safetykitten]

65. That's the ticket. Cut care, doctors, so no imposition on the insurance. Genius!

[Recursion]

66. How is that what I said?

Our health care costs too much. That's why our insurance (private and social) costs too much. Why would reducing costs mean cutting care?

[mdmc]

42. Let me know when the bill will help me fund my treatment

I am fully insured but cannot afford medical care. I will be able to once the illness disables me. But until then, I am very sick and very disappointed.

[Recursion]

44. Have you looked at a FQHC?

http://findahealthcenter.hrsa.gov/Search_HCC_byAddr.aspx

[mdmc]

48. thanks for the link

according to my (two) liberal congress critters (I live in Newburgh, work in NW - one is in NYSCD19, the other in NYSCD22) there is no help for me at all.
The Family Health Center of Greater Newburgh is my local clinic. They don't have the doctors I need.

I will check your link to see if there is any benefit. THanks again and peace / low stress..

[Recursion]

49. Best of luck

I wasn't suggesting that was going to be an easy panacea; I only mentioned it because a lot of people don't seem to know about federally qualified clinics.

[mdmc]

53. tons of clinics

just none that have the specialist I need.

Again, I am very sick, in a great deal of pain, and could be healthy if I had the money to pay for treatment.
I'm just tired and disappointed.

I can agree that HCR is a "step" in the "right" direction. I just can't get excited because my poor quality of life prevents me from doing so.

[Recursion]

54. Sorry to hear that

And, yes, it's idiotic that you have to wait until your condition debilitates you to be able to afford it. I wish I knew a solution.

[mdmc]

56. I wish we knew the POLITICAL solution my friend

I think we all know what the solution is - we just don't know how to get past the politics of the solution (I mean if a Dem supermajority can't get a public option, then what?).

Peace and thanks for the replies and thoughts.

[Recursion]

57. I'm not convinced that the way we pay for it is all of the problem

I think how much we pay for it is part of it too, and that solving the first won't solve the second. Specialists and their equipment cost a lot of money, which is why private insurance (and Medicare, for that matter) doesn't like paying for them. We need to find a way to make whatever treatment you need cost less to begin with.

[mdmc]

61. yes

Frankly, I never thought much about it until I got sick. Now it consumes me.

[dkf]

77. Oh the irony...covered by health insurance but have to go to a free health clinic.

It's a dream come true for the health insurance industry. Its like being a 24 hour fitness Member and never using the equipment nor the classes. Or being a netflix subscriber and keeping the same DVD for years.

[Recursion]

79. I dunno. Maybe insurance shouldn't be for day-to-day medical needs

(Now, what he's describing doesn't describe a day-to-day need; I only mentioned FQHC's in case they could offer some help.)

My car insurance isn't for changing the oil or rotating the tires, you know?

[dkf]

83. If it was a pure catastrophic policy people probably would refuse to pay $150 for a doctors visit

And $250 for some blood tests. Let's face it...the cost of health services are ridiculous.

[Recursion]

86. Bingo

the cost of health services are ridiculous.

Yes. And the way we pay for health services hides those costs from most of us, so we don't think to do anything about it.

[dkf]

87. Yes and doctors need those kinds of rates to live their lifestyles.

That is why under this lifestyle, a significant monthly fee must be extracted from everyone. A free market system would not support these rates.

[Hello_Kitty]

95. If the cost of your insurance premiums are preventing you from paying for day to day stuff

That's a problem.

My car insurance isn't for changing the oil or rotating the tires, you know?

Which is why people should really stop making the comparison to car insurance when defending the mandate.

[Recursion]

98. Car insurance as an analogy

It's a bad analogy because day-to-day care is expensive enough that we use insurance for it. It's a bad way to pay for things but it's what we have for the foreseeable future, unless we can get prices for care down.

[Fumesucker]

59. Tens of thousands getting covered..

While there are tens of millions who lack coverage.

One tenth of one percent of the actual need.

Not to mention that insurance coverage by no means guarantees you're going to get care.

[Recursion]

63. What would provide a guarantee of getting care?

Medicare denies claims too. At a higher rate than private insurance plans do, for that matter.

[Fumesucker]

67. Nothing I guess..

I'm pretty much resigned to dying if I become seriously ill.

Thanks for your support..

[Amonester]

72. How does it feel now, uh?

Okie dokie with what Fumesucker just replied to you?

Or, maybe you're feeling lucky you got yours, so screw everyone (like Fumesucker) else?

Inquiring minds want to know.

Thanks.

[Recursion]

73. How does what feel now? I agree with him

As long as health care costs as much as it does, changing the way we pay for it isn't going to make things much better.

[Amonester]

74. If Fs (and the millions like him) would be fortunate enough to be a

Canadian citizen (for example), they wouldn't risk devolopping ulcers (or worse) worrying about what will happen to them if they get sick.

But they're not.

Let's give it all to the Military-Industrial-Complex deep pockets instead.

US number 1!

[Recursion]

75. Except that the provinces are starting to have trouble affording their systems

http://www.reuters.com/article/idUSTRE64U3XO20100531

Already, Quebec is starting to charge user fees, and Alberta and Saskatchewan are dropping people who can't pay their premiums.

[Amonester]

78. Let's see.

> Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.

So the Pharmatical-Industrial-Complex deep pockets get less bonuses. Nothing wrong with that, doesn't it?

Next.

> British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.

Federal law states that imposing such fees is illegal, it's the law. Nothing wrong with that too.

OTOH, Provinces won't raise taxes on the rich who managed to not pay taxes on an estimated $88 billion they moved out of the country, in fiscal paradises, since they argue they 'must' remain 'competitive' with their US counterpart... (the wealthiest 1%). Now, that is something that is definitely wrong, isn't it?

[Amonester]

85. And Quebec has NOT started to charge user fees.

Neo-Liberals there have just TALKED about it, and since then, they have suffered a major drop in all polls...

[Skittles]

89. do you not freaking get it?

"COVERAGE" means health insurance companies get paid - IT DOES NOT MEAN PEOPLE GET HEALTHCARE

[Fumesucker]

91. Actually I do get it..

That I choose to argue a certain point does not mean I don't understand other points.

Indeed, I made your point in different post on this very thread.

[Skittles]

103. sorry Fumesucker

sans glasses, replying to wrong post

scheduling myself for ass-kicking :D

[Cleita]

84. I work in a doctors office and so far the patients

I have talked to in the office are still telling the same old tales about their insurance premiums going up, not getting much coverage and still getting claims denied. My stepdaughter is fighting with their insurance right now because they are refusing to pay for half of the cost of a surgery her husband had and that they agreed to pay for most of it initially but now have decided not to. They just changed the rules, lied about what they would cover and it seems that they can and there is no law that is changing that.

[Skittles]

88. which is exactly what I expected after reading that POS bill

:mad:

[area51]

90. The health care bill is working?

Perhaps you'd better tell the woman referenced in this thread. Oh, wait -- you can't -- she's dead.

[activa8tr]

94. Good story! Let's see if we can get more in local papers.

And on the TV machine Rachel keeps talking about.

[Hello_Kitty]

96. It's not lost on me how the things that kick right away mostly help middle class people

High risk pools only help you if you can afford the premium. Letting your kid stay on your policy until 26 is only an option if you have a job with insurance benefits. Nothing wrong with those things, per se, but it might have been smart to do something for all the struggling and unemployed people right away. Like an emergency Medicaid plan. That might have given all those millions of people a reason to get out and vote Dem. But no, they helped a bunch of (mostly) white people with money and most of them will turn around and vote Repug.

[bvar22]

101. Are you aware that the term "Medical Bankruptcy" in unknown in the civilized World,

but even after every provision in this "historic" reform kicks in,
Medical Bankruptcy will STILL be Big Business in the good ole USA.

"A Uniquely American Solution"....indeed.

"By their works you will know them."

[Amonester]

102. The Health Care Bill is Stupid (Just Don't Tell Anyone)

When you think about it, very deeply: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x560044

there's really no reason not to believe the for-profit health insurance system is as far away from a wise system as it is close to a very deeply Stupid system (as it is clearly explained at the above link), don't you think?

Thought so.